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Return Document to Name Mailing Address City State Zip Affidavit of Death I being first duly sworn upon oath depose and say the following Name of Beneficiary signed and recorded a beneficiary deed with the intent to convey the Name of Grantor following property located in Montana described as follows Name of County 2. The beneficiary deed was recorded in Book Page County on Month Instrument Number 3. The grantor died on Day Year. At the time of death the grantor had not revoked the above described beneficiary deed* 4. The following person s is/are the person s named as the grantee beneficiary ies under the beneficiary deed described above and are entitled to succeed to the grantor s interest in the real property described above as a result of the grantor s death Grantee Beneficiary Name Dated this day of Date Signature of Grantor s State of Montana County of This instrument was signed before me on Print name of signer s Notary Signature Montana notaries must complete the following if not part of stamp* Printed Name Affix seal/stamp as close to signature as possible. The beneficiary deed was recorded in Book Page County on Month Instrument Number 3. The grantor died on Day Year. At the time of death the grantor had not revoked the above described beneficiary deed* 4. The following person s is/are the person s named as the grantee beneficiary ies under the beneficiary deed described above and are entitled to succeed to the grantor s interest in the real property described above as a result of the grantor s death Grantee Beneficiary Name Dated this day of Date Signature of Grantor s State of Montana County of This instrument was signed before me on Print name of signer s Notary Signature Montana notaries must complete the following if not part of stamp* Printed Name Affix seal/stamp as close to signature as possible.

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